scholarly journals Efficiency and thoroughness trade-offs in high-volume organisational routines: an ethnographic study of prescribing safety in primary care

2017 ◽  
Vol 27 (3) ◽  
pp. 199-206 ◽  
Author(s):  
Suzanne Grant ◽  
Bruce Guthrie
Keyword(s):  
Primary Care ◽  
Participant Observation ◽  
High Volume ◽  
Ethnographic Study ◽  
Trade Offs ◽  
High Workload ◽  
Organisational Routines ◽  
The Face ◽  
General Practices ◽  
Context Specific

BackgroundPrescribing is a high-volume primary care routine where both speed and attention to detail are required. One approach to examining how organisations approach quality and safety in the face of high workloads is Hollnagel’s Efficiency and Thoroughness Trade-Off (ETTO). Hollnagel argues that safety is aligned with thoroughness and that a choice is required between efficiency and thoroughness as it is not usually possible to maximise both. This study aimed to ethnographically examine the efficiency and thoroughness trade-offs made by different UK general practices in the achievement of prescribing safety.MethodsNon-participant observation was conducted of prescribing routines across eight purposively sampled UK general practices. Sixty-two semistructured interviews were also conducted with key practice staff alongside the analysis of relevant practice documents.ResultsThe eight practices in this study adopted different context-specific approaches to safely handling prescription requests by variably prioritising speed of processing by receptionists (efficiency) or general practitioner (GP) clinical judgement (thoroughness). While it was not possible to maximise both at the same time, practices situated themselves at various points on an efficiency-thoroughness spectrum where one approach was prioritised at particular stages of the routine. Both approaches carried strengths and risks, with thoroughness-focused approaches considered safer but more challenging to implement in practice due to GP workload issues. Most practices adopting efficiency-focused approaches did so out of necessity as a result of their high workload due to their patient population (eg, older, socioeconomically deprived).ConclusionsHollnagel’s ETTO presents a useful way for healthcare organisations to optimise their own high-volume processes through reflection on where they currently prioritise efficiency and thoroughness, the stages that are particularly risky and improved ways of balancing competing priorities.

scholarly journals Alternatives to the face-to-face consultation in general practice: focused ethnographic case study

2018 ◽  
Vol 68 (669) ◽  
pp. e293-e300 ◽  
Author(s):  
Helen Atherton ◽  
Heather Brant ◽  
Sue Ziebland ◽  
Annemieke Bikker ◽  
John Campbell ◽  
...  
Keyword(s):  
General Practice ◽  
Participant Observation ◽  
Health Issues ◽  
Ethnographic Case Study ◽  
Structured Interviews ◽  
Face To Face ◽  
The Face ◽  
General Practices ◽  
The One

BackgroundNHS policy encourages general practices to introduce alternatives to the face-to-face consultation, such as telephone, email, e-consultation systems, or internet video. Most have been slow to adopt these, citing concerns about workload. This project builds on previous research by focusing on the experiences of patients and practitioners who have used one or more of these alternatives.AimTo understand how, under what conditions, for which patients, and in what ways, alternatives to face-to-face consultations present benefits and challenges to patients and practitioners in general practice.Design and settingFocused ethnographic case studies took place in eight UK general practices between June 2015 and March 2016.MethodNon-participant observation, informal conversations with staff, and semi-structured interviews with staff and patients were conducted. Practice documents and protocols were reviewed. Data were analysed through charting and the ‘one sheet of paper’ mind-map method to identify the line of argument in each thematic report.ResultsCase study practices had different rationales for offering alternatives to the face-to-face consultation. Beliefs varied about which patients and health issues were suitable. Co-workers were often unaware of each other’s practice; for example, practice policies for use of e-consultations systems with patients were not known about or followed. Patients reported benefits including convenience and access. Staff and some patients regarded the face-to-face consultation as the ideal.ConclusionExperience of implementing alternatives to the face-to-face consultation suggests that changes in patient access and staff workload may be both modest and gradual. Practices planning to implement them should consider carefully their reasons for doing so and involve the whole practice team.

scholarly journals Knowledge mobilisation: an ethnographic study of the influence of practitioner mindlines on atopic eczema self-management in primary care in the UK

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e025220 ◽  
Author(s):  
Fiona Cowdell
Keyword(s):  
Primary Care ◽  
Atopic Eczema ◽  
Ethnographic Study ◽  
Self Management ◽  
Useful Knowledge ◽  
Inaccurate Information ◽  
Technological Developments ◽  
Primary Care Practitioners ◽  
Context Specific ◽  
The Uk

ObjectiveTo explore how atopic eczema specific mindlines are developed by primary care practitioners.DesignEthnographic study.SettingOne large, urban general practice in central England.ParticipantsIn observation, all practitioners and support staff in the practice and in interviews a diverse group of practitioners (n=16).ResultsObservation of over 250 hours and interview data were combined and analysed using an ethnographic approach through the lenses of mindlines and self-management. Three themes were identified: beliefs about eczema, eczema knowledge and approaches to self-management. Eczema mindlines are set against a backdrop of it being a low priority and not managed as a long-term condition. Practitioners believed that eczema is simple to manage with little change in treatments available and prescribing limited by local formularies. Practice is largely based on tacit knowledge and experience. Self-management is expected but not often explicitly facilitated. Clinical decisions are made from knowledge accumulated over time. Societal and technological developments have altered the way in which practitioner mindlines are developed; in eczema, for most, they are relatively static.ConclusionsThe outstanding challenge is to find novel, profession and context-specific, simple, pragmatic strategies to revise or modify practitioner mindlines by adding reliable and useful knowledge and by erasing outdated or inaccurate information thus potentially improve quality of eczema care.

scholarly journals Community Nurse-Paramedics' Sphere of Practice in Primary Care; an ethnographic study

2020 ◽  
Author(s):  
Tuija Rasku ◽  
Marja Kaunonen ◽  
Elizbeth Thyer ◽  
Eija Paavilainen ◽  
Katja Joronen
Keyword(s):  
Primary Care ◽  
Content Analysis ◽  
Participant Observation ◽  
Ethnographic Study ◽  
Care Providers ◽  
Community Nurse ◽  
Structured Interviews ◽  
Care Needs ◽  
Way Of Thinking ◽  
Practice Methods

Abstract Background Primary care, the principal function of the healthcare system, needs efforts from the local primary healthcare teams. Community Paramedicine has managed to reduce the use of Emergency Medical Services (EMS) for non-emergent calls. For the paramedic to move from traditional emergency call outs to non-emergency care means new demands. There is a paucity of paramedics’ experiences and perceptions of their novel roles as community paramedics. This study aimed to explore the community nurse-paramedics experiences of their new sphere of practice. Methods A descriptive ethnographic research was conducted collecting data through participant observation (total 317 hours) and semi-structured interviews (N = 24) in three Hospital Districts where the community nurse-paramedics (CNP) have worked at least one year. Both data were combined, organized, and analyzed with inductive content analysis. Results From the inductive content analysis, five themes emerged: the CNP's new way of thinking, the broad group of patients, the demanding way to provide care, the diversity of multi-agency collaboration and management challenges. The CNP needs an appropriate attitude for the care and the broader way of thinking than before, taking care of the patient but also about the family members. The CNPs pointed out as enablers for the way of providing care as challenges for the management of the CNP model. The diversity of multiagency collaboration team can be sensitive while offering new possibilities. Conclusion The CNP's deep involvement in patients' and families' care needs and the challenges of CNPs’ skills and competences. Their professional attitudes and eagerness to develop and maintain the multi-agency collaboration can offer preventive and long-term caring solutions from which the citizens and allied health, safety, and social care providers benefit locally and globally.

scholarly journals Receptionists’ role in new approaches to consultations in primary care: a focused ethnographic study

2018 ◽  
Vol 68 (672) ◽  
pp. e478-e486 ◽  
Author(s):  
Heather Dawn Brant ◽  
Helen Atherton ◽  
Annemieke Bikker ◽  
Tania Porqueddu ◽  
Chris Salisbury ◽  
...  
Keyword(s):  
Primary Care ◽  
Ethnographic Study ◽  
New Approach ◽  
Team Members ◽  
Face To Face ◽  
New Approaches ◽  
General Practices ◽  
Alternative Approaches ◽  
The Uk

BackgroundThe receptionist is pivotal to the smooth running of general practice in the UK, communicating with patients and booking appointments.AimThe authors aimed to explore the role of the receptionist in the implementation of new approaches to consultations in primary care.Design and settingThe authors conducted a team-based focused ethnography. Three researchers observed eight general practices across England and Scotland between June 2015 and May 2016.MethodInterviews were conducted with 39 patients and 45 staff in the practices, all of which had adopted one or more methods (telephone, email, e-consultation, or internet video) for providing an alternative to face-to-face consultation.ResultsReceptionists have a key role in facilitating patient awareness regarding new approaches to consultations in primary care, while at the same time ensuring that patients receive a consultation appropriate to their needs. In this study, receptionists’ involvement in implementation and planning for the introduction of alternative approaches to face-to-face consultations was minimal, despite the expectation that they would be involved in delivery.ConclusionA shared understanding within practices of the potential difficulties and extra work that might ensue for reception staff was lacking. This might contribute to the low uptake by patients of potentially important innovations in service delivery. Involvement of the wider practice team in planning and piloting changes, supporting team members through service reconfiguration, and providing an opportunity to discuss and contribute to modifications of any new system would ensure that reception staff are suitably prepared to support the introduction of a new approach to consultations.

Mara B. Adelman & Lawrence R. Frey, The fragile community: Living together with AIDS. (Everyday communication: Case studies of behavior in context.) Mahwah, NJ: Erlbaum, 1997. Pp. xii, 128. Hb $36.00, pb $16.50.

2000 ◽  
Vol 29 (2) ◽  
pp. 277-279
Author(s):  
Anssi Peräkylä
Keyword(s):  
Case Studies ◽  
Participant Observation ◽  
Ethnographic Study ◽  
Residential Facility ◽  
Peter Berger ◽  
Living Together ◽  
The Face ◽  
Analysis Society ◽  
Sacred Canopy ◽  
Everyday Communication

In his book The sacred canopy, Peter Berger wrote, that in the last analysis, “society” is people banded together in the face of death (1967:51). Adelman and Frey have written a small but fascinating study about this very topic. Theirs is an ethnographic study on a residential facility called Bonaventure House (BH), run by a Catholic order, the Alexian Brothers of America. The residents suffer from AIDS; and during the time of the study, BH was for most of them their last home before death. Using participant observation, interviews and questionnaires, Adelman & Frey set out to study how community is built and sustained in these circumstances: People afflicted by a dreaded illness share their everyday lives; death occurs regularly; and the departed are replaced by new people, who become part of the community.

scholarly journals ‘It's all about patient safety’: an ethnographic study of how pharmacy staff construct medicines safety in the context of polypharmacy

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e042504
Author(s):  
Nina Fudge ◽  
Deborah Swinglehurst
Keyword(s):  
Safety Concern ◽  
Participant Observation ◽  
Ethnographic Study ◽  
Community Pharmacies ◽  
Pharmacy Staff ◽  
Professional Boundaries ◽  
The Face ◽  
Per Se ◽  
Depth Interviews

ObjectiveAs polypharmacy increases, so does the complexity of prescribing, dispensing and consuming medicines. Medication safety is typically framed as the avoidance of harm, achievable through adherence to policies, guidelines and operational standards. Automation, robotics and technologies are positioned as key players in the elimination of medication error in the face of escalating demand, despite limited research illuminating how these innovations are taken up, used and adapted in practice. We explore how ‘safety’ is constructed and accomplished in community pharmacies in the context of polypharmacy.Design and settingIn-depth ethnographic case study across four community pharmacies in England (December 2017–July 2019). Data collection entailed 140 hours participant observation and 19 in-depth interviews. Practice theory informed the analysis.Participants33 pharmacy staff (counter staff, technicians, dispensers, pharmacists).ResultsIn their working practices related to polypharmacy, staff used the term ‘safety’ in explanations of why and how they were doing things in particular ways. We present three interlinked analytic themes within an overarching narrative of care: caring for the technology; caring for each other; and caring for the patient. Our study revealed a paradox: polypharmacy was visible, pervasive and productive of numerous routines, but rarely discussed as a safety concern per se. Safety meant ensuring medicines were dispensed as prescribed, and correcting errors pertaining to individual drugs through the clinical check. Pharmacy staff did not actively challenge polypharmacy, even when the volume of medicines dispensed might indicate ‘high risk' polypharmacy, locating the responsibility for polypharmacy with prescribing clinicians.Conclusion‘Safety’ in the performance of practices relating to polypharmacy was not a fixed, defined notion, but an ongoing, collaborative accomplishment, emerging within an organisational narrative of ‘care’. Despite meticulous attention to ‘safety’, carefully guarded professional boundaries meant that addressing polypharmacy per se in the context of community pharmacy was beyond reach.

Young Muslim America

2018 ◽  
Author(s):  
Muna Ali
Keyword(s):  
Public Discourse ◽  
Participant Observation ◽  
Cultural Citizenship ◽  
Ethnographic Study ◽  
Muslim American ◽  
Daily Lives ◽  
Community Culture ◽  
Identity Studies ◽  
Anthropology Of Islam ◽  
Dominant Narratives

This book explores the identities, perspectives, and roles of the second and subsequent generations of Muslim Americans of both immigrant and convert backgrounds. As these younger Muslims come of age, and as distant as they are from historical processes that shaped their parents’ generations, how do they view themselves and each other? What role do they play in the current chapter of Islam in a post-9/11 America? Will they be able to cross intra-community divides and play a pivotal role in shaping their community? Culture figures prominently in the discussions about and among Muslims and is centered on four dominant narratives: 1) culture is thought to be the underlying cause of an alleged “identity crisis,” 2) it presumably contaminates a “pure/true” Islam, 3) it is the cause for all that divides Muslim American immigrants and converts, which could be remedied by creating an American Muslim community and culture, and 4) some Americans fear an “Islamization of America” through a Muslim cultural takeover. In this ethnographic study, Muna Ali explores these questions through these four dominant narratives, which are both part of the public discourse and themes that emerged from interviews, a survey, social and traditional media, and participant observation. Situating these questions and narratives in identity studies in a pluralistic yet racialized society, as well as in the anthropology of Islam and in the process and meaning of cultural citizenship, Ali examines how younger Muslims see themselves and their community, how they negotiate fault lines of ethnicity, race, class, gender, and religious interpretation within their communities, and how their faith informs their daily lives and how they envision a future for themselves in post-911 America.

scholarly journals Trends in Antibiotic Prescribing in Out-of-Hours Primary Care in England from January 2016 to June 2020 to Understand Behaviours during the First Wave of COVID-19

Antibiotics ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 32
Author(s):  
Nina J. Zhu ◽  
Monsey McLeod ◽  
Cliodna A. M. McNulty ◽  
Donna M. Lecky ◽  
Alison H. Holmes ◽  
...  
Keyword(s):  
Primary Care ◽  
Time Series ◽  
Patient Outcomes ◽  
Broad Spectrum ◽  
Antibiotic Prescribing ◽  
Broad Spectrum Antibiotic ◽  
Out Of Hours ◽  
Broad Spectrum Antibiotics ◽  
National Quality ◽  
General Practices

We describe the trend of antibiotic prescribing in out-of-hours (OOH) general practices (GP) before and during England’s first wave of the COVID-19 pandemic. We analysed practice-level prescribing records between January 2016 to June 2020 to report the trends for the total prescribing volume, prescribing of broad-spectrum antibiotics and key agents included in the national Quality Premium. We performed a time-series analysis to detect measurable changes in the prescribing volume associated with COVID-19. Before COVID-19, the total prescribing volume and the percentage of broad-spectrum antibiotics continued to decrease in-hours (IH). The prescribing of broad-spectrum antibiotics was higher in OOH (OOH: 10.1%, IH: 8.7%), but a consistent decrease in the trimethoprim-to-nitrofurantoin ratio was observed OOH. The OOH antibiotic prescribing volume diverged from the historical trend in March 2020 and started to decrease by 5088 items per month. Broad-spectrum antibiotic prescribing started to increase in OOH and IH. In OOH, co-amoxiclav and doxycycline peaked in March to May in 2020, which was out of sync with seasonality peaks (Winter) in previous years. While this increase might be explained by the implementation of the national guideline to use co-amoxiclav and doxycycline to manage pneumonia in the community during COVID-19, further investigation is required to see whether the observed reduction in OOH antibiotic prescribing persists and how this reduction might influence antimicrobial resistance and patient outcomes.

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